搜尋結果： : " MAKE FREEDHARDEMAN UNIVERSITY "
Special Programs - Tobacco Cessation Services
acco Cessation Services Provider Education Resources Smoking Cessation Resources - Help your patients quit Tobacco The CDC's Brief Tobacco Intervention ASK In a caring manner, at each visit, ...if your patients use tobacco If they do not, congratulate them If they do, proceed to next step ADVISE Patients who use tobacco to consider quitting. Tobacco products can lead to health problems such as... Heart and Lung Disease Diabetes Stroke Ongoing infections and colds Cancer People exposed to secondhand smoke can also experience these health problems REFER If the patient is interested in quitting, connect them to KICK IT CA and any other local resource (below) Prescribe medications (if appropriate) Congratulate your patient on the decision to quit If patient is not ready to quit, user personalized motivational messages to encourage quitting. Let them know you are here when they are ready. Kick it CA How it works: Patient will receive services from a Coach that has undergone rigorous training & apprenticeships, participates in weekly monitoring and case reviews, and attend continuing education courses on cultural competency. To enroll, patients can call, chat, or complete an online web form. The patient will then receive a Kick-Off call to collect their basic information and find out what they are trying to quit. Right after kick-off, coaching begins. The patient will receive clinically sound motivational interviewing. The coach will help patient put together a quit plan and set a quit date. The patient will then receive check-ins at times they are most susceptible to relapse. The coach will see if their quit-plan is working and help them modify as needed. Phone Number: English - 1 (800) 300-8086 Spanish - 1 (800) 600-8191 Website: KICKITCA.ORG Text: For English: Text "Quit Smoking" or "Quit Vaping" to 66819 For Spanish: Mande "Dejar de Fumar" o "No Vapear" to 66819 Other Smoking Cessation Resources: Link to Resources on Member page: https://iehp.org/en/members/healthy-living?target=smoking-cessation Resources in the Inland Empire: Connect IE Information and Training for Providers: http://www.CAquits.com https://www.cdc.gov/tobacco/ Local Tobacco Control Projects: Tobacco Free San Bernardino County: https://healthcollaborative.org/SBCTobaccoControl/ Tobacco Free Riverside County: https://www.rivcotcp.org/ (Back to Tobacco Cessation Services Menu) Tobacco Cessation Services By clicking on these links, you may be leaving the IEHP website. Training: Comprehensive Tobacco Cessation Services for Medi-Cal Members (PDF) The Smoking Cessation Leadership Center's (SCLC): Recordings Available for CME/CE Credit Kick it CA Education, Training and Technical Assistance: https://kickitca.org/health-professionals 5 Major Steps to Intervention: http://www.ahrq.gov/professionals/clinicians-providers/guidelines-recommendations/tobacco/5steps.html Tobacco Cessation CPT Codes for Identification ACA Facts Sheets and Resources (American Lung Association): https://www.lung.org/policy-advocacy/healthcare-lung-disease/healthcare-policy/affordable-care-act-tobacco Helpline: https://kickitca.org/ (also available in Spanish, Chinese, Korean, and Vietnamese) https://kickitca.org/health-professionals https://kickitca.myshopify.com/collections/all Continuing Medical Education California courses offered through UC Schools of Medicine: https://cmecalifornia.com/Education.aspx Tip: Use key word in search: Tobacco Cessation Centers for Disease Control Coverage for Tobacco Use Cessation Treatments: https://www.cdc.gov/tobacco/quit_smoking/cessation/coverage/ Patients Not Ready to Make a Quit Attempt Now (The “5 R’s”): http://www.ahrq.gov/sites/default/files/wysiwyg/professionals/clinicians-providers/guidelines-recommendations/tobacco/5rs.pdf Smokefree.gov: https://smokefree.gov/help-others-quit/health-professionals University of California San Francisco’s Smoking Cessation Leadership Center’s Tools and Resources: https://smokingcessationleadership.ucsf.edu/ USPSTF-Tobacco Smoking Cessation in Adults, Including Pregnant Women: Behavioral and Pharmacotherapy Interventions: https://www.uspreventiveservicestaskforce.org/uspstf/index.php/recommendation/tobacco-use-in-adults-and-pregnant-women-counseling-and-interventions USPSTF-Tobacco Use in Children and Adolescents: Primary Care Interventions: https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/tobacco-and-nicotine-use-prevention-in-children-and-adolescents-primary-care-interventions (Back to Tobacco Cessation Services Menu) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Member Testimonials - Our Members
group of students from the Inland Empire. More than 30 recipient students grew up in the Inland Empire and more than 50% are first generation medical students and grew up in low-income households. Through the scholarship fund, aspiring healthcare professionals will be guided through the system and connected to the health plan’s provider network. This allows students to pursue successful careers in healthcare immediately after graduation to help support the region’s growing population. Loma Linda University School of Medicine Inland Empire Medical Community Service Awardees Class of 2022 Ye Jin Jeon Ye Jin's Why: “I applied for the Inland Empire Medical Community Service Award because the goal and priority to expand access to care and healthcare provider options for the Southern California region aligns with my calling. As a child growing up in the San Bernardino County, I saw the economic disproportion within my own neighborhood, and this compelled me…God has led me pursue my medical career” Class of 2024 Edwin Choque Edwin's Why: “Simply put, my heart lies in the Inland Empire. This community of individuals have fostered me and loved me since I was a child and all I can hope is to pay that love and care forward. . . . My dream is to be on the front lines as a representative for these individuals who frequently become marginalized…” University of California, Riverside Dean's Mission Recipients Four Year Award Elizabeth Celaya-Ojeda Elizabeth's Why: “I want to work particularly with the underserved in this area because I truly believe that being a physician is a privilege and with that there is a responsibility to be an advocate for those who are facing health disparities. I am particularly interested in providing care to underserved Native American and Hispanic communities. Not many healthcare providers are aware of the disparities these two communities face and I want to be an advocate for them, especially in the Inland Empire.” Alfonso Parocua Alfonso's Why: “Growing up, my family lacked meaningful access to healthcare and relied on a local free clinic as our only means of interacting with a physician. Through my personal experience with the free clinic, I developed a passion for service to the underserved communities who lack meaningful access to basic healthcare amenities due to low socioeconomic status. I sought opportunities that would allow me to pay my gratitude forward by becoming part of the solution to healthcare disparities in Inland Southern California. Through my volunteer efforts in free clinics and other community involvement programs, I witnessed the passion and dedication that health care providers and volunteers in the area have towards the underserved community. This realization deepened my connection to Inland Southern California because I was reminded so much of the health care professionals that helped my family when they couldn't help themselves.” Two Year Award Cesar Fortuna Cesar's Why: “A San Bernardino native, I have had the opportunity to volunteer in my community as a Spanish language translator for free clinics. Most patients I have spoken with fell into the category of uninsured, underinsured, or undocumented. It became clear the extent of need in this region when I would translate to the providers that this was the first-time dozens of our patients had ever seen a medical professional; however, this wasn’t uncommon. To these patients and their stories, I thank them because they inspire me to pursue Emergency Medicine where I can become a valuable player in providing care, providing resources, or providing comfort.” Lavinia Mitroi Lavinia's Why: “My goal of pursuing a career at the intersection of medicine and public health is driven by a desire to put patients and communities at the center of our health care system in the U.S. This desire was sparked most poignantly by my own experiences as an IEHP patient growing up in the Inland Empire. As I prepare for a future career as a pediatrician in this region, I hope to serve as an advocate for children and families, providing direct health services but also creating systems change.” Armando Navarro Armando's Why: “The earliest memory of my grandfather is him telling me, “Mijo, tienes que aprender Español para ayudar tu comunidad, you have to learn how to speak Spanish to help your community”. These words were often repeated to me by my grandfather who lamented the fact that he only spoke Spanish. I witnessed the health disparities affecting my community; doctors who did not speak Spanish, parents who could not afford a trip to the doctors’ office, and a healthcare system that was not inclusive of my community’s culture. I have a duty to give back to a school, a community, that has given me so much.” Christ Ordookhanian Christ's Why: “I see the medical profession through the lens of an individual who had lived through challenging times and witnessed how one individual provider can make such and impact when their heart is in the right place. My dedication to our underserved community stems from that of a lifelong mission I have set for myself which is to ensure I give back to a community that I am deeply associated with, they are my founding roots in the United States, and I vow to be at the forefront of the next generation of physicians that care and give the underserved hope.” University of California, Riverside Dean's Mission Recipients Daphne Du Daphne's Why: “I spent most of my life in underprivileged areas and saw firsthand how difficult healthcare access could be through inadequate financial resources, transportation, or translation services. Thanks to this investment in my studies, there is less stress in my life. I can focus on my studies and eventually give back to the community by becoming a physician who will advocate for patients without meaningful access to health care.” Judith Gonzales Judith's Why: “As a first-generation college student, there have always been many barriers in my path to higher education. I am the eldest daughter of an immigrant family, and it is truly an honor to be able to reach this point in my education and in my career, and to give back to my parents who have sacrificed so much for me and my sisters. Growing up in an underserved community showed me the long-lasting impacts of health inequities and strengthened my resolve to pursue a career in medicine. Working in the Inland Empire, I hope to not only address, but actively work towards combating the health inequity present in our communities.” Jordan Hough Jordan's Why: “Despite disadvantages encountered when living in a low-income community, I am grateful for the privilege I had in meeting physicians dedicated to their practice and willing to share that love through mentorship. These individuals have served as exemplary medical professionals and have encouraged me to follow in their footsteps. As a future physician, I aspire to empathetically care for patients by allowing my past experiences to enhance my understanding of their needs. I also plan to incorporate teaching into patient care by presenting opportunities for students to shadow and be mentored for a career in medicine.” Diana Martinez Diana's Why: “I am the daughter of Mexican Immigrants and grew up in Compton, California where I unfortunately was quickly desensitized to violence and was able to tell the difference between a firework and a gun shot. My mother had to travel a significant distance to ensure we had adequate healthcare. Despite these conditions, my parents always stressed education and did their best to give me what I needed. These life circumstances ignited my passion to serve those in disadvantaged communities, which I interacted with throughout my educational career. The Inland Empire Health Program Scholarship means I can achieve my dream –by practicing medicine in a community that deserves adequate, equitable, and accessible healthcare. I will serve as a bilingual physician in the Inland Empire that can serve families like my own and many more.”
Plan Updates - Vaccine Resources
2-2023 influenza season continues to coincide with circulation of COVID-19 virus (SARS-CoV-2). As of August 2022, approximately 94.2 million cases of COVID-19 had been reported in the United States. Influenza vaccination remains an important tool for the prevention of potentially severe respiratory illness, which helps decrease the stress on the U.S. health care system. IEHP DualChoice members who are 18 years of age or older may obtain flu vaccines through the IEHP Pharmacy Vaccine Network. Vaccine Notice: Access to Pharmacy Vaccine Network (PDF) Frequently Asked Influenza (Flu) Questions: 2022-2023 Season (CDC Recommendations) What’s New for 2022-2023 By clicking on these links, you will be leaving the IEHP website. The composition of flu vaccines has been updated. For the 2022-2023 flu season, there are three flu vaccines that are preferentially recommended for people 65 years and older. These are Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant flu vaccine and Fluad Quadrivalent adjuvanted flu vaccine. The recommended timing of vaccination is similar to last season. For most people who need only one dose for the season, September and October are generally good times to get vaccinated. Vaccination in July and August is not recommended for most adults but can be considered for some groups. While ideally it’s recommended to get vaccinated by the end of October, it’s important to know that vaccination after October can still provide protection during the peak of flu season. The age indication for the cell culture-based inactivated flu vaccine, Flucelvax Quadrivalent (ccIIV4), changed from 2 years and older to 6 months and older. Pre-filled Afluria Quadrivalent flu shots for children are not expected to be available this season. However, children can receive this vaccine from a multidose vial at the recommended dose. Mpox Information Mpox Vaccination Locations San Bernardino County: Monkeypox (mpox) – Department of Public Health Riverside County: Mpox Vaccine Locations – Riverside University Health System Please advise members to call before going in for a vaccination as some locations are only available with appointments. Members may make appointments for the JYNNEOS vaccine at https://myturn.ca.gov/. Mpox Testing As of December 8, 2022, no commercial testing is available for the diagnosis of Mpox. Providers may contact CDC in the diagnosis, management of patients with suspected Mpox, and for any additional information regarding Mpox connect with the CDC Emergency Operations Center. Phone: 1-770-488-7100, Monday through Friday, 8:00 AM to 4:30 PM EST After Hours Phone: 1-404-639-2888 Treatment Mpox patients usually recover fully within 2-4 weeks without the need for medical treatment. While there are no treatments specifically for Mpox, the virus that causes Mpox is similar to the smallpox virus and therefore antiviral drugs developed to protect against smallpox may be used. The antiviral drug, tecovirimat (TPOXX), has been approved by the FDA to treat smallpox in adults and children. If you prescribe tecovirimat to treat members with Mpox the member must sign a consent form stating tecovirimat is an investigational drug that has not yet been approved by the FDA for treatment of Mpox. More information about tecovirimat visit https://www.cdc.gov/poxvirus/monkeypox/if-sick/treatment.html. Preventive Services Information Immunizations By clicking on these links, you will be leaving the IEHP website. CDC ACIP Vaccine Recommendations and Guidelines: https://www.cdc.gov/vaccines/hcp/acip-recs/index.html CDC ACIP Immunization Schedule for Children: https://www.cdc.gov/vaccines/schedules/hcp/child-adolescent.html CDC ACIP Immunization Schedule for Adults: https://www.cdc.gov/vaccines/schedules/hcp/adult.html USPSTF Task Force's Immunization Recommendations: https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=immunization California Immunization Registry Portal (CAIR): https://cair.cdph.ca.gov/CAPRD/portalInfoManager.do Immunization Timing 2022 (PDF) Medicare-Medicaid (MMP) Quality Withhold Measures California Specific Quality Withhold Technical Notes for DY 2 to 8 (PDF) Core Quality Withhold Technical Notes for DY 2 to 10 (PDF) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Provider Resources - Health and Wellness
and achieve health goals. IEHP’s Health & Wellness Programs help Members learn how to manage their health and make healthy lifestyle changes. You can refer your IEHP Members to these programs anytime by logging into the Secure Provider Website and completing the Health Education Program Request Form. Health Resources Kids and Teens Managing Your Illness Pregnancy and Postpartum Senior Health Weight Management Health & Wellness Brochures and Handouts Inland Empire Health Plan (IEHP) offers many Wellness Programs that focus on the health and well-being of our Members. All of our programs are free, join us at our next session and learn ways to stay healthy. Get information on important health topics through our health education brochures and handouts: Controlling Asthma (PDF) Diabetes. What's next? (PDF) Eat Healthy, Feel Better (PDF) Fever in Children (PDF) Flu Decision Guide (PDF) Flu Shot (PDF) High Blood Pressure (PDF) Immunizations - English (PDF) Immunizations - Spanish (PDF) Immunizations - Chinese (PDF) Immunizations - Vietnamese (PDF) PAP and HPV Tests: What to Expect (PDF) Diabetes Prevention Program (DPP) - Live the Life You Love Format: Online (small group) Duration: One year Ages: 18 years and over This online year-long lifestyle change program helps you make real changes that last. During the first 6 months, you will meet weekly with a small online group to learn how to make healthy choices into your life. In the second 6 months, you will meet monthly to practice what you have learned. No person is alike, so the program will be tailored to meet your needs and honor your customs and values. You will also be paired with a health coach for one year to help you set your goals, such as how to: Eat healthier Add physical activity into your daily life Reduce stress Improve problem-solving and coping skills Studies have shown that those who finish the program can lose weight and prevent Type 2 Diabetes. Small changes can have big results! Let's start living the best version of you and living the life you love. Find out if you qualify! Click here to visit the Skinny Gene Project online, or Call Skinny Gene Project at (909) 922- 0022, Monday - Friday 8am – 5pm., or Email email@example.com For Providers DPP Rx Pad (PDF) Educational Resources 2021 Population Needs Assessment (PNA) Report IEHP’s Population Needs Assessment (PNA) identifies Member health status and behaviors, Member health education priorities, cultural/linguistics needs, health disparities, and gaps in service related to these issues. The findings of the PNA may help Providers better understand and serve our Members. For questions, please contact IEHP Health Education Department at firstname.lastname@example.org 2021 Population Needs Assessment (PNA) Report Loving Support Program IEHP supports and sponsors the Loving Support Program that is run by Riverside University Health System (RUHS). Loving Support is a program committed to helping mothers achieve their breastfeeding goals. This service offers help and support with the first days at home, return to work, support groups, and timely answers to challenges nursing mothers face. Members can directly contact the Loving Support 24/7 Helpline at 888-451-2499. No referral is necessary. English and Spanish-speaking certified lactation specialists and Internationally Board Certified Lactation Consultants (IBCLCs) are available 24 hours a day, 7 days a week to answer questions. Messages are recorded after hours and promptly addressed. Member Education Resources The following websites are good sources of easy-to-read patient information that can be downloaded, printed, or ordered. By clicking on these links, you will be leaving the IEHP website. RESOURCE DESCRIPTION Medline Plus A service of the US National Library of Medicine and the National Institutes of Health. Easy to read information and audio tutorials on many health topics in English and Spanish. Topics are available in multiple languages. Food and Drug Administration - Office of Women's Health Easy-to-read handouts in English, Spanish and other languages on nutrition, diabetes, depression, and other topics related to women’s health. Learning About Diabetes, Inc. Easy to read “Handouts and Visual Aids” in color on diabetes care and nutrition to help patients eat the right foods to control blood sugar. Weight Control Information Network An extensive list of health education materials about healthy weight and physical activity in English and Spanish. Materials can be printed or ordered. Health Information Translations Easy-to-read educational handouts on many health topics and in multiple languages. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Provider Resources - Compliance
h plan operations in compliance with ethical standards, contractual obligations under State and Federal programs, laws, and regulations applicable to Medi-Cal and IEHP DualChoice. This commitment extends to our business associates and delegated entities that support IEHP’s mission to organize and improve the delivery of quality, accessible, and wellness based healthcare services for our community. Our Compliance Program is designed to: Ensure we comply with applicable laws, rules, and regulations Reduce or eliminate Fraud, Waste, and Abuse (FWA) Prevent, detect, and correct non-compliance Reinforce our commitment to culture of compliance for which we strive Establish and implement our shared commitment to honesty, integrity, transparency, and accountability Code of Business Conduct and Ethics Inland Empire Health Plan (IEHP) expects Team Members and business entities doing business with IEHP to conduct business activities in an ethical and professional manner that promotes public trust and confidence in the integrity of IEHP. The Code is meant to provide guidance about the compliance culture at IEHP and the role that each Team Member, including management, Chief Officers and the Governing Board, plays in building and preserving that culture. IEHP Code of Business Conduct and Ethics (PDF) Compliance, Fraud, Waste, and Abuse (FWA), and Privacy Program Training The IEHP Compliance, FWA, and Privacy Training Program focuses on the elements of an effective Compliance Program, conduct & ethics, and the Fraud, Waste and Abuse and Privacy Programs. IEHP requires delegated entities to provide Compliance Training to their employees, Providers, downstream entities, Board of Directors, and Contractors within 90 days of hire/start, and annually thereafter. IEHP is committed to a culture of compliance, ethics, and integrity. The goal of Compliance Training is to provide all associated parties the ability to demonstrate awareness of IEHP’s requirements, including regulations and policies & procedures associated with Compliance as it relates to daily work. If you have questions or additional suggestions, please e-mail the IEHP Compliance Department at email@example.com. Compliance Training FWA HIPAA Privacy and Security (PDF) Eligibility to Participate in Federal and State Health Care Programs Inland Empire Health Plan (IEHP) is prohibited from issuing payment for services provided, ordered, or prescribed by an individual or entity that is excluded, ineligible, or terminated from participation in State and Federal health care programs in accordance with regulatory and contractual requirements. IEHP conducts regular reviews of Federal and State exclusionary databases and lists, including but not limited to: Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE list) GSA Excluded Parties List System (EPLS) DHCS Medi-Cal Suspended and Ineligible Provider List CMS Preclusion List Restricted Provider Database (RPD) Exclusion Screening IEHP has implemented a screening process to identify individuals and entities that appear on the DHHS OIG LEIE, the GSA EPLS, the CMS Preclusion List and the DHCS Medi-Cal Suspended and Ineligible Provider List prior to appointment, contracting, and/or employment and monthly thereafter to ensure that none of these individuals or entities are excluded, ineligible or terminated from participation in State and Federal health care programs. Delegated entities must implement a screening program for employees, Board Members, contractors, and business partners to avoid relationships with individuals and/or entities that tend toward inappropriate conduct. This program includes but is not limited to: Prior to contract and monthly thereafter, review of the GSA System for Award Management (SAM), the Department of Health Care Services Medi-Cal Suspended and Ineligible list, and the Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE) that are excluded from participation in government health care programs (42 CFR §10011901). A monthly review of the Department of Health Care Services Medi-Cal Suspended and Ineligible list. Criminal record checks when appropriate or as required by law. Review of the National Practitioner Databank (NPDB). Review of professional license status for sanctions and/or adverse actions. Reporting results to Compliance Committee, Governing Body, and IEHP as necessary. Fraud, Waste, and Abuse (FWA) IEHP has established a Fraud, Waste, and Abuse Program to detect, correct, and prevent fraud, waste, and abuse on part of Team Members, IEHP Members, Providers, Vendors, delegated entities and any other entity doing business with IEHP. Fraud Prevention Fraud Prevention, it’s a Team Effort In an effort to prevent fraud and abuse, IEHP encourages Providers and their staff to report any suspicious circumstances when they arise. You may want to ask for another form of identification in addition to the IEHP Member identification card. Identification with both a picture and a signature, such as a valid driver’s license or State identification card, are suggested. We are informing Members of this concern and are requesting that they have additional identification available when they come to you. To obtain more compliance guidelines, the Department of Health and Human Services (HHS) offers assistance (by clicking on this link you will be leaving the IEHP website). Fraud is knowingly and willfully executing, or attempting to execute, a scheme or artifice to defraud any health care benefit program, or to obtain, by means of false or fraudulent pretenses, representations, or promises, any of the money or property owned by, or under the custody or control of, any health care benefit program. Examples include: Knowingly billing for services or prescriptions not furnished or supplies not provided Knowingly altering claim forms for a higher payment Selling medicine, medical equipment, or other things received through IEHP Waste includes overuse of services, or other practices that, directly or indirectly, result in unnecessary costs. Waste is generally not considered to be caused by criminally negligent actions but rather by the misuse of resources. Examples include: Conducting excessive office visits Writing excessive prescriptions or ordering excessive tests Prescribing more medications than necessary for the treatment of a specific condition Abuse includes actions that may, directly or indirectly, result in unnecessary costs and improper payment or services. Abuse involves payment for items or services when there is no legal entitlement to that payment and the provider has not knowingly and/or intentionally misrepresented facts to obtain payment. Examples include: Billing for unnecessary medical services or medical equipment Billing for brand name drugs when generics are dispensed Misusing codes on a claim, such as upcoding and unbundling codes. Report potential FWA Click Here (By clicking on this link, you will be leaving the IEHP website). Privacy Incident/Breach IEHP has established a HIPAA Privacy Program to ensure that Member’s health information is properly protected while allowing the flow of health information needed to provide and promote high-quality health care. A privacy breach is defined as unauthorized acquisition, access, use, or disclosure of protected health information (PHI) which compromises the security or privacy of such information. PHI is health information that relates to a Member’s past, present or future physical or mental health or condition, including the provision of his/her health care, or payment for that care and contains personally identifiable information (PII) such as name, SSN, DOB, Member ID, address, or any other unique identifier related to the Member. This generally means that a breach occurs when PHI is accessed, used, or disclosed to an individual or entity that does not have a business reason to know that information. The law does allow information to be accessed, used, or disclosed when it is related to treatment, payment, or healthcare operations directly associated with the work that we do at IEHP on behalf of our Members. Report a Privacy Incident/Breach Click Here (By clicking on this link, you will be leaving the IEHP website). Reporting Information IEHP has the following resources available for reporting fraud, waste or abuse, privacy issues, and other compliance issues: Compliance Hotline: (866) 355-9038 Fax: (909) 477-8536 E-mail: firstname.lastname@example.org. Mail: IEHP Compliance Officer P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 Online: (By clicking on this link, you will be leaving the IEHP website) Report a Compliance Issue: Click Here Report a Privacy Incident/Breach: Click Here Report potential FWA: Click Here Frequently Asked Questions (FAQs) What are some common examples of fraud? Providers Billing for services not rendered Paying a "kickback" in exchange for a referral for medical services or goods Unbundling Overcharging for services or goods Using false credentials Members Allowing unauthorized individuals to use ID card to obtain benefits Altering prescriptions Falsifying residence information to obtain benefits Drug seeking or doctor shopping to obtain narcotics What do I do if I suspect an IEHP Member is engaging in possible fraud, waste, or abuse? First, document your suspicions. Then, contact IEHP’s Compliance Department at (866) 355-9038 and make a report with one of our Representatives. At times, IEHP may request additional information that is necessary to investigate. IEHP also has the following resources available for reporting fraud, waste or abuse, privacy issues, and other compliance issues: Compliance Hotline: (866) 355-9038 Fax: (909) 477-8536 E-mail: email@example.com Mail: IEHP Compliance Officer P.O. Box 1800 Rancho Cucamonga, CA 91729-1800 Online: (By clicking on the following links, you will be leaving the IEHP website) Report a Compliance Issue Click Here Report a Privacy Incident/Breach Click Here Report potential FWA Click Here What do I do if my facility has made some billing errors? If you suspect that errors in billing may have occurred, contact your IEHP Provider Services Representative at (909) 890-2054. What are some other things I can do as a Provider? Periodically perform internal audits of billing practices and compare billing records with payments received. Do not leave prescription pads, which include a Provider's identification and license number, out in the open. For example, do not store prescription pads in exam room cabinets or leave on office counters. IEHP DualChoice (HMO D-SNP) Model of Care Training The Centers for Medicare & Medicaid Services (CMS), the Department of Health Care Services (DHCS) and the National Committee for Quality Assurance (NCQA) require that IEHP staff and contracted consultants/vendors, our Medicare IPAs, Hospitals/SNFs, and Providers, receive training on the Plan’s Model of Care for our D-SNP Members: Interdisciplinary Care Team (ICT) Fact Sheet (PDF) IEHP DualChoice (HMO D-SNP) Model of Care Training (PDF) IEHP DualChoice (HMO D-SNP) Model of Care Training (HTML) *We recommend opening file in: Mozilla Firefox, MS Edge or MS Internet Explorer Contact the OIG The Office of the Inspector General (OIG) is there to assist you and maintains a hotline, which offers a confidential means for reporting vital information. For information on confidentiality, please contact the hotline and ask about their confidential source program. Each caller is encouraged to assist the OIG by providing information on how they can be contacted for additional information but the caller may remain anonymous. Contacting the Office of the Inspector General Phone: (800) HHS-TIPS (447-8477) E-mail: Htips@oc.dhhs.gov Additional Hotlines DHCS Medi-Cal Fraud Hotline Phone: (800) 822-6222 E-mail: firstname.lastname@example.org Web: https://apps.dhcs.ca.gov/stopfraud/Default.aspx The recorded message may be heard in English and 10 other languages: Spanish, Vietnamese, Cantonese, Armenian, Hmong, Cambodian, Laotian, Farsi, Korean and Russian. The call is free and the caller may remain anonymous. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
領導團隊 - Vinil Devabhaktuni, MBA
計、開發、實施及支援 IEHP 的系統。 Vinil 最近從 Health New England 轉職到 IEHP，他在 Health New England 擔任資訊科技長並負責管理獨特的產品組合，而且將科技的角色從支援功能提升至策略性合作夥伴，在組織增長期間扮演重要角色。Vinil 也為銷售、包銷及會計研發及執行端對端營運藍圖。此外，他重新規劃和簡化生產支援及應用程式發展作業，為組織賦予穩定性、可預測性及最佳化。 在 Vinil 任職於 Health New England 之前，Vinil 擔任過紐約市 AIG 的副總裁暨數位轉型官。在擔任此職務期間，他推動 $5,000 萬美元的全球數位轉型計畫，其中包含來自全球 140 個國家/地區的移轉及整合數位財產。 Vinil 擁有 Longmeadow Bay Path University 的企業管理碩士 (MBA) 學位。
- Well-care Visit
our child stay healthy. During the well-care visit, the Doctor will complete a physical exam, and make sure you or your child are up to date on all shots. Please call your Doctor today and set up a well-care visit to get needed shots, screenings or exams. What do you need to do? Get a well-care visit with your or your child’s Doctor by 12/15/23.* The Doctor will send proof of the visit to IEHP. Once IEHP receives proof of the visit, a reward certificate will be mailed.** Choose your gift card from the list of major companies online, over the phone or by mail, and your $25 gift card will be mailed to you.*** Questions? Call IEHP Member Services at 1-800-440-IEHP (4347), Monday–Friday, 7am–7pm, and Saturday–Sunday, 8am–5pm. TTY users should call 1-800-718-4347. *Member must be eligible with IEHP on the day of the exam and at the time of gift card distribution. **Reward certificate may be mailed up to two weeks after IEHP receives proof of your exam. ***After choosing your gift card, please allow two to three weeks for delivery. Note: Gift card cannot be used to purchase alcohol, tobacco or firearms.
Pharmacy Services - Academic Detailing
treach program for our providers and pharmacies. We perform phone and one-on-one outreaches with physicians, nurse practitioners, physician assistants, and pharmacy staff. Our goal is to transform the prescriber and pharmacy practice and enhance the provider, pharmacist and member experience. Clinical Drug Education Clinical Drug Education provides materials that focus on a specific drug, drug class, and/or disease state. These materials contain pharmacological and clinical practice information to assist providers and pharmacies in their practice. As new drug information is available, it is important to stay up to date on clinical research findings to assist with member care and medication-use decisions. Practice Development Practice development education provides materials that focus on enhancing provider and member experience. The materials contain guidance on Formulary Utilization and PA submissions as well as insights regarding electronic prescribing and electronic health records. It is our commitment to provider practice optimization tools and resources to enhance member care. You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Click here to download a free copy by clicking Adobe Acrobat Reader. By clicking on this link, you will be leaving the IEHP website. Biosimilars A growing trend in healthcare is the use of biosimilar drugs. The following information will assist you and your practice on prescribing biosimilars. What is a Biosimilar? (PDF) Biosimilars: Are They the Same Quality? (PDF) Biological Product Definitions (PDF) Prescribing Biosimilar Products (PDF) Prescribing Interchangeable Products (PDF) Opioid and Chronic Pain Management In collaboration with Riverside University Health System (RUHS) and Centers for Disease Control and Prevention (CDC), IEHP would like to provide the following information to assist you and your practice on prescribing opioids for chronic pain management. CURES CURES FAQ (PDF) CURES 2.0 User Guide (PDF) CURES tips and tricks (PDF) Naloxone Naxolone Drug facts (PDF) Naxolone instructions for use (PDF) First Responder Naxolone administration fact sheet (PDF) Opioid Prescribing Guidelines Medication Assisted Treatment (MAT) and Opioid Treatment Program (OTP) FAQ (PDF) CDC Guideline Infographic (PDF) CDC Guidelines Factsheet (PDF) TurnTheTide Pocket Guide for Prescribing Opioids for Chronic Pain (PDF) CDC Guideline at a Glance Opioid Tapering Clinical Pocket Guide to Tapering (PDF) Tapering Resource-AAFP (PDF) Opioid Tapering Resource pack (PDF) Pharmacy Medication Assisted Treatment (MAT) for Substance Abuse (PDF) Urine Drug Testing CDC Clinical Practice Guideline for Prescribing Opioids for Pain UDT for monitoring opioid therapy-AAFP (PDF) X-Waiver X-Waiver resources Removal of DATA Waiver (X-Waiver) Requirement https://www.samhsa.gov/medications-substance-use-disorders/removal-data-waiver-requirement All prescriptions for buprenorphine will now only require a standard DEA registration number. For additional information on the removal of the DATA-Waiver requirement, see the Removal of DATA Waiver (X-Waiver) Requirement. Practice Optimization Electronic Prescribing (e-Rx) Electronic prescribing is a growing standard in the healthcare industry. Most electronic health record systems offer electronic prescription capabilities. The information below will provide insight to the practice of e-prescribing. Benefits of e-Rx brochure (PDF) Formulary Utilization The IEHP Formulary offers a variety of drugs based on safety and efficacy for any condition. The information below will help you find out how to access and interpret the formulary Medicare FAQ (PDF) The process of submitting a prior authorization may be cumbersome for your practice. The information below will help you understand this process and assist with receiving a proper decision in a timely manner. For any questions regarding Pharmacy Academic Detailing Training please contact: PharmacyAcademicDetailing@iehp.org You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. Click here to download a free copy by clicking Adobe Acrobat Reader. By clicking on this link, you will be leaving the IEHP website. Information on this page is current as of January 1. 2022
Join Our Network - Hospitals
CA 92324 (909) 580-1000 (909) 580-6308 Barstow Community Hospital 820 E Mountain View Barstow, CA 92311 (760) 256-1761 (760) 957-3397 Bear Valley Community Healthcare District 41870 Garstin Drive Big Bear Lake, CA 92315 (909) 866-6501 (909) 878-8282 Chino Valley Medical Center 5451 Walnut Ave. Chino, CA 91710 (909) 464-8600 (909) 464-8882 Colorado River Medical Center 1401 Baily Ave. Needles, Ca. 92363 (909) 326-7100 (909) 326-7292 Community Hospital of San Bernardino 1805 Medical Center Dr #201 San Bernardino, CA 92411 (909) 887-6333 (909) 806-1044 Corona Regional Medical Center 800 S Main St. Corona, CA 92882 (951) 737-4343 (951) 736-6310 Desert Regional Medical Center 1150 N Indian Canyon Dr. Palm Springs, CA 92262 (760) 323-6511 (760) 323-6330 Desert Valley Hospital 16850 Bear Valley Rd. Victorville, CA 92395 (760) 241-8000 (760) 951-2034 Eisenhower Medical Center 39800 Bob Hope Dr. Rancho Mirage, CA 92270 (760) 340-3911 (760) 773-1532 Hemet Global Medical Center 1117 E Devonshire Ave. Hemet, CA 92543 (951) 652-2811 (951) 765-4745 Hi-Desert Medical Center 6601 White Feather Rd. Joshua Tree, CA 92252 (760) 366-3711 (760) 365-9309 Inland Valley Regional Medical Center 36485 Inland Valley Dr., Wildomar, CA 92595 (951) 677-1111 (951) 698-7721 John F. Kennedy Memorial Hospital 47111 Monroe St. Indio, CA 92201 (760) 347-6191 (760) 775-8014 Loma Linda University Children's Hospital 11234 Anderson St. Loma Linda, CA 92354 (909) 558-8000 (909) 558-3278 Loma Linda University Medical Center 11234 Anderson St. Loma Linda, CA 92354 (909) 651-1702 (909) 478-3202 Loma Linda University Medical Center - Murrieta 28062 Baxter Rd. Murrieta, CA 92563 (951) 290-4000 (951) 290-4092 Menifee Global Medical Center 28400 McCall Blvd. Sun City, CA 92585 (951) 679-8888 (951) 766-6470 Montclair Hospital Medical Center 5000 San Bernardino St. Montclair, CA 91763 (909) 625-5411 (909) 626-4777 Mountains Community Hospital 29101 Hospital Rd. Lake Arrowhead, CA 92352 (909) 336-3651 (909) 336-4730 Palo Verde Hospital 250 N 1st St. Blythe, Ca 92225 (760) 922-4115 (760) 921-5263 Parkview Community Hospital Medical Center 3865 Jackson St. Riverside, CA 92503 (951) 688-2211 (951) 352-5363 Pomona Valley Hospital Medical Center 1798 N. Garey Ave. Pomona, CA 91767 (909) 865-9500 (909) 865-2104 Rancho Springs Medical Center 25500 Medical Center Dr. Murrieta, CA 92562 (951) 696-6000 (619) 627-5949 Redlands Community Hospital 350 Terracina Blvd. Redlands, CA 92373 (909) 335-5500 (909) 335-6497 Riverside Community Hospital 4445 Magnolia Ave. Riverside, CA 92501 (951) 788-3000 (951) 788-3201 Riverside University Health Care System 26520 Cactus Ave. Moreno Valley, CA 92555 (951) 486-4000 (951) 486-4475 San Antonio Regional Hospital 999 San Bernardino Rd. Upland, CA 91786 (909) 985-2811 (909) 920-6357 San Gorgonio Memorial Hospital 600 N Highland Springs Ave., Banning, CA 92220 (951) 845-1121 (951) 845-2836 St. Bernardine Medical Center 2101 N Waterman Ave., San Bernardino, CA 92404 (909) 883-8711 (909) 881-4337 St. Mary Medical Center 18300 US Highway 18 Apple Valley, CA 92307-2206 (760) 242-2311 (760) 946-8714 Temecula Valley Hospital 31700 Temecula Pkwy Temecula, CA 92592 (951) 331-2200 (951) 331-2211 Victor Valley Global Medical Center 15248 Eleventh St. Victorville, CA 92395 (760) 245-8691 (760) 245-6996
Clinical Information - Medication Therapy Management
MTM is a term to describe a broad range of services offered by Pharmacists on our health care team. The IEHP Clinical Pharmacy Team reviews the Members’ medicines, making sure they’re taking the right ones for their health conditions. If you are a Provider for IEHP Members who qualify for the MTM Program, you can let them know to look out for a letter from us. They will be enrolled automatically—unless they opt-out. MTM is offered to Members at no additional cost. IEHP's MTM services include these core elements: Medication therapy reviews Medication education Disease management A team of Pharmacists and Doctors developed these MTM services to help provide better prescription drug coverage for our Members. For example, MTM also helps identify possible medication errors. Medicare MTM Program This is a free program under Medicare Part D for IEHP DualChoice Members who have multiple medical conditions, take many prescription drugs, and have high drug costs to assist with better medication management and overall health. IEHP DualChoice Members’ enrollment includes a yearly comprehensive medication review (CMR) and regular targeted medication review (TMR) services throughout the year. MTM services include: Comprehensive Medication Review (CMR) An IEHP Clinical Pharmacist will provide an annual comprehensive review of the IEHP DualChoice Member’s medications over the phone. The Pharmacist will review IEHP DualChoice Member’s medications and make clinical recommendations to IEHP DualChoice Members and Providers. Targeted Medication Review (TMR) The IEHP Clinical Pharmacy Team will also offer TMRs through the year by reviewing issues with the participating IEHP DualChoice Member’s medicines. The team will perform TMRs for all enrolled beneficiaries every three months. The beneficiary may get TMR recommendations by mail and their Primary Care Provider may receive recommendations by fax—if the IEHP Clinical Pharmacy Team deems it necessary. For more information, IEHP DualChoice Members eligible for CMR or TMR services can call 1-877-273-IEHP (4347), 8am-5pm (PST), 7 days a week, including holidays. TTY users should call 1-800-718-4347. Click here for a blank personal medication list. Medicare MTM Program services may have limited eligibility criteria. They are available for the following conditions: 1. The IEHP DualChoice Member has a minimum of three (3) disease states: Bone Disease-Arthritis-Osteoporosis Bone Disease-Arthritis-Rheumatoid Arthritis Chronic Heart Failure (CHF) Diabetes Dyslipidemia End-Stage Renal Disease (ESRD) Hypertension Mental Health Chronic/ Disabling Mental Health Conditions Respiratory Disease – Asthma Respiratory Disease – Chronic Obstructive Pulmonary Disease (COPD) 2. The IEHP DualChoice Member is prescribed a minimum of five (5) different medications to treat those disease states: ACE-Inhibitors Angiotensin II Receptor Blockers (ARBs) Antidepressants Antihyperlipidemic Antihypertensives Antipsychotics Beta Blockers Bronchodilators Calcium Channel Blockers Disease-Modifying Anti-Rheumatic Drugs (DMARDs) Diuretics Insulins Oral Hypoglycemics Selective Serotonin Reuptake Inhibitors (SSRIs) Tumor Necrosis Factors (TNFs) Inhaled Corticosteroids Calcimimetic Cardiac Glycoside Colony Stimulating Factors Glucagon-Like Peptide-1 Glucocorticosteroids Neprilysin Inhibitor NSAIDs Phosphate Binders Vitamin D Analogs 3. Drug costs of $1,233.75 (one-fourth of $4,935) for the previous three months are likely to be incurred. To learn more about MTM, call IEHP DualChoice (HMO-DSNP) at 1-877-IEHP (4347), 8am-8pm (PST), 7 days a week, including holidays. TTY users should call 1-800-718-4347. For answers to frequently asked questions, please download the FAQ document below: MTM FAQs (PDF) For details, contact the IEHP Pharmaceutical Services Department at (909) 890-2049, Monday-Friday, 8am-5pm. IEHP DualChoice (HMO-D-SNP) [Medicare-Medicaid Plan] is a Health Plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Information on this page is current as of March 2023. H5355_CMC_20_1900233_Accepted
Join Our Network - Community Supports
offer in place of services or settings covered under the Medicaid State Plan. These services should be medically appropriate and cost-effective alternatives. Beginning January 1, 2022, IEHP began offering 11 DHCS Preapproved Community Supports services. Effective July 1, 2023, 3 additional services were added. Please click on the service for additional details. Asthma Remediation Community Transition Services/Nursing Facility Transition to a Home Home Modifications Housing Deposits Housing Tenancy and Sustaining Services Housing Transition Navigation Services Medically Supportive Food/Meals/Medically Tailored Meals Nursing Facility Transition/Diversion to Assisted Living Facilities, such as Residential Care Recuperative Care (Medical Respite) Short-Term Post-Hospitalization Housing Sobering Centers (Riverside County) Day Habilitation Personal Care and Homemaker Services Respite Services Community Supports FAQs (PDF) Please return the completed Community Supports Service Provider Assessment (PDF) via email to DGCommunitySupportTeam@iehp.org You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Provider Resources - Non-Contracted Provider Resources
s for Contracted and Non-Contracted Providers Emergency and Post-Stabilization Care for IEHP Members IEHP DualChoice (HMO D-SNP) Model of Care Training for Non-Contracted Providers Provider Referral Outside of the IEHP Network Provider Dispute Resolution Process for Contracted and Non-Contracted Providers Definition of a Provider Dispute A provider dispute is a written notice from the provider to Inland Empire Health Plan (IEHP) that: Challenges, appeals, or appeals, or requests reconsideration of a claim (including a bundled group of similar claims) that has been denied, adjusted, or contested Challenges a request for reimbursement for an overpayment of a claim Seeks resolution of a billing determination or other contractual dispute What is not Considered to be a Provider Dispute Claims denied for missing or additional documentation requirements such as consent forms, invoices, Explanation of Benefits from primary carrier, or itemized bills are not considered Provider Disputes Corrected Claims Pre-Service Authorization Denials Provider Dispute Time Frame IEHP accepts disputes from providers if they are submitted within 365 days of receipt of IEHPs decision (for example, IEHPs Remittance Advice (RA) indicating a claim was denied or adjusted). Submission of Provider Disputes When submitting a provider dispute, a provider should use a Provider Dispute Resolution Request form. If the dispute is for multiple, substantially similar claims, complete the spreadsheet on page 2 of the Provider Dispute Resolution Request Form All Provider Disputes and supporting information must be submitted to: IEHP Claims Appeal Resolution Unit PO BOX 4319 Rancho Cucamonga, CA 91729-4349 Acknowledgement of Provider Dispute IEHP acknowledges receipt of each provider dispute, regardless of whether the dispute is complete, within 15 business days of receipt. Resolution Timeframe IEHP resolves each provider dispute within 45 business days following receipt of the dispute, and provides the provider with a written determination stating the reasons for determination. PDR Determination Resulting in Additional Payment If IEHP determines to pay additional monies based on information originally provided and/or available at the time the claim was first presented to IEHP for adjudication, or a result of a processing error IEHP will automatically include the appropriate interest amount if payment is not issued within required regulatory timeframes. Non-Contracted Provider Disputes Resolution Process for IEHP DualChoice (HMO D-SNP) A non-contracted provider, on his or her own behalf, is permitted to file a standard appeal for a denied claim only if the non-contracted provider completes a waiver of liability statement, which provides that the non-contracted provider will not bill IEHP DualChoice (HMO D-SNP) Plan Members. Who to Call with Questions on IEHPs PDR Process Contracted providers may visit our online secure provider portal at www.iehp.org for more information. Providers may also call the IEHP Provider Call Center at (909) 890-2054 or (866) 223-4347 Monday-Friday, 8:00 am to 5pm PST. (Back to Non-Contracted Providers Menu) Emergency and Post-Stabilization Care for IEHP Members Triage and Advice Systems IEHP provides Members triage, screening, and advice services by telephone 24 hours a day, 7 days a week through its Nurse Advice Line (NAL). By calling the NAL, Members receive assistance with access to urgent or emergency services from an on-call physician, or licensed triage personnel. IEHP Members can reach this 24/7 Nurse Advice Line at (888)-244-IEHP (4347) or 711 (TTY). Post-Stabilization Care IEHP requires contracted and non-contracted hospitals to obtain prior authorization for post-stabilization care for Members (patients). IEHP requests the patient’s diagnosis as indicated by the treating physician or surgeon and any other information reasonably necessary for the Plan to decide on whether to authorize post-stabilization care or to assume management of the patient’s care by prompt transfer to another facility. The hospital should request prior authorization from IEHP’s Utilization Management (UM) Department by: Phone at (866) 649-6327; or Fax at (909) 477-8553 to send clinical notes for medical necessity review. IEHP makes every effort to respond to requests for necessary post-stabilization care within thirty (30) minutes of receipt. The services are considered approved if IEHP does not respond within this timeframe. All subsequent hospital day are subject to review for medical necessity. IEHP will inform the provider of the Plan’s decision and will coordinate the transfer of the Member if IEHP denies the request for authorization of post-stabilization care and elects to transfer the Member to another health care provider. Non-Emergency Services If a Member presents at the emergency department for non-emergency services, please refer the Member to their IEHP Member Handbook, section 3 (How to Get Care), which outlines the process for obtaining a referral. Claims Reimbursement Complete facility claims for authorized health care services must be sent to: Inland Empire Health Plan Attn: Claims Department – IEHP Direct PO BOX 4349 Rancho Cucamonga, CA 91729-4349 Complete professional claims for authorized health care services must be sent to: For IEHP-Direct Members, please send to address above. For IEHP Members assigned to an IPA, please click for here for more information on how to send to the appropriate IPA. Billing IEHP Members Providers under the Medi-Cal program must not submit claims to, demand or otherwise collect reimbursement from a Medi-Cal beneficiary, or from other persons on behalf of the beneficiary, for any service included in the Medi-Cal program’s scope of benefits in addition to a claim submitted to the Medi-Cal program for that service. (Back to Non-Contracted Providers Menu) IEHP DualChoice (HMO D-SNP) Model of Care Training for Non-Contracted Providers The Centers for Medicare & Medicaid Services (CMS), the Department of Health Care Services (DHCS), and National Committee for Quality Assurance (NCQA) requirement that out-of-network providers routinely seen by IEHP DualChoice (HMO D-SNP) Members, receive training on IEHPs Model of Care for our D-SNP Members: IEHP DualChoice (HMO D-SNP) Model of Care Training (PDF) IEHP DualChoice (HMO D-SNP) Model of Care Training (HTML) *We recommend opening file in: Mozilla Firefox, MS Edge, Chrome or MS Internet Explorer 2023 IEHP DualChoice (HMO D-SNP) Model of Care eAOR 2023 IEHP DualChoice (HMO D-SNP) Model of Care Non-Contracted Provider AOR (PDF) Report an Issue To report any issues with this system or process or for any questions, please send an email to DGHospitalRelationsServiceTeam@iehp.org (Back to Non-Contracted Providers Menu) Provider Referral Outside of the IEHP Network In cases where an out-of-network provider that has been approved to provide service(s) to an IEHP Member and needs to refer said IEHP Member to another out-of-network provider, the approved out-of-network provider must first contact the Member’s IPA to request the referral. The Member’s IPA will review the request for referral and provide a decision within regulatory timeframes. The Member’s IPA will approve the request if it is deemed medically necessary and if IEHP or the IPA does not have an appropriate alternative provider available within its network. If you have any questions or if you would like to request a referral, please reach out to the Member’s IPA. (Back to Non-Contracted Providers Menu) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Special Programs - Community Supports
atives that MCPs may offer in place of services or settings covered under the California Medicaid State Plan. Beginning January 1, 2022, IEHP began offering 11 DHCS Preapproved Community Supports services. Effective July 1, 2023, 3 additional services were added. Please click on the service for additional details. Asthma Remediation Environmental Asthma Trigger Remediations are physical modifications to a home environment that are necessary to ensure the health, welfare, and safety of the individual, or enable the individual to function in the home and without which acute asthma episodes could result in the need for emergency services and hospitalization. Community Transition Services/Nursing Facility Transition to a Home Assist members to live in the community and avoid further institutionalization. These services are non-recurring set-up expenses for individuals who are transitioning from a licensed facility to a living arrangement in a private residence where the person is directly responsible for his or her own living expenses. Environmental Accessibility Adaptations (Home Modifications) Environmental Accessibility Adaptations (EAAs also known as Home Modifications) are physical adaptations to a home that are necessary to ensure the health, welfare, and safety of the individual, or enable the individual to function with greater independence in the home: without which the Member would require institutionalization. Housing Deposits Housing Deposits assist with identifying, coordinating, securing, or funding one-time services and modifications necessary to enable a person to establish a basic household that do not constitute room and board. Housing Tenancy & Sustaining Services This service provides tenancy and sustaining services, with a goal of maintaining safe and stable tenancy once housing is secured. Housing Transition Navigation Services Housing transition services assist Members with obtaining housing. Medically Supportive Food/Meals/Medically Tailored Meals Malnutrition and poor nutrition can lead to devastating health outcomes, higher utilization, and increased costs, particularly among Members with chronic conditions. Meals help individuals achieve their nutrition goals at critical times to help them regain and maintain their health. Results include improved Member health outcomes, lower hospital readmission rates, a well-maintained nutritional health status, and increased Member satisfaction. Nursing Facility Transition/Diversion to Assisted Living Facilities Nursing Facility Transition/Diversion services assist individuals to live in the community and/or avoid institutionalization when possible. The goal is to both facilitate nursing facility transition back into a home-like, community setting and/or prevent skilled nursing admissions for Members with an imminent need for nursing facility level of care (LOC). Individuals have a choice of residing in an assisted living setting as an alternative to long-term placement in a nursing facility when they meet eligibility requirements. Recuperative Care (Medical Respite) Recuperative care, also referred to as medical respite care, is short-term residential care for individuals who no longer require hospitalization, but still need to heal from an injury or illness (including behavioral health conditions) and whose condition would be exacerbated by an unstable living environment. An extended stay in a recovery care setting allows individuals to continue their recovery and receive post-discharge treatment while obtaining access to primary care, behavioral health services, case management and other supportive social services, such as transportation, food, and housing. Short-Term Post-Hospitalization Housing Short-Term Post-Hospitalization housing provides Members who do not have a residence and who have high medical or behavioral health needs with the opportunity to continue their medical/psychiatric/substance use disorder recovery immediately after exiting an inpatient hospital (either acute or psychiatric or Chemical Dependency and Recovery hospital), residential substance use disorder treatment or recovery facility, residential mental health treatment facility, correctional facility, nursing facility, or recuperative care and avoid further utilization of State plan services. Sobering Centers (Riverside County) Sobering centers are alternative destinations for individuals who are found to be publicly intoxicated (due to alcohol and/or other drugs) and would otherwise be transported to the emergency department or jail. Sobering centers provide these individuals, primarily those who are homeless or those with unstable living situations, with a safe, supportive environment to become sober. Day Habilitation Programs Effective July 1st - Day Habilitation Programs are provided in a participant’s home or an out-of-home, non-facility setting. The programs are designed to assist the participant in acquiring, retaining, and improving self-help, socialization, and adaptive skills necessary to reside successfully in the person’s natural environment. Respite Services Effective July 1st - These are provided to caregivers of participants who require intermittent temporary supervision. The services are provided on a short-term basis because of the absence or need for relief of those persons who normally care for and/or supervise them and are non-medical in nature. Personal Care and Homemaker Services Effective July 1st - This service is provided for individuals who need assistance with Activities of Daily Living (ADL), such as bathing, dressing, toileting, ambulation, or feeding. Personal Care Services can also include assistance with Instrumental Activities of Daily Living (IADL), such as meal preparation, grocery shopping, and money management. IEHP Direct and Delegated Providers can submit referrals for Community Supports via the Provider Portal. For questions on how to submit a referral or more information relating to the above services, Providers can call the Provider Call Center at (909) 890-2054 or (866) 223-4347. Please continue to direct IEHP Members needing additional information on Community Supports services to IEHP Member Services at (800) 440-4347, Monday - Friday, 8am - 5pm. TTY users should call (800) 718-4347. If you have programmatic questions, please email DGCommunitySupportTeam@iehp.org Community Supports Provider Brochure - English (PDF) | Spanish (PDF) | Chinese (PDF) | Vietnamese (PDF) Community Supports FAQs (PDF) Medi-Cal Community Supports or In Lieu of Services (ILOS) Policy Guide (PDF) You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
CalAIM - Pay for Performance (P4P)
th Care Services (DHCS), California Advancing and Innovating Medi‐Cal (CalAIM) is a long‐term commitment to transform and strengthen Medi‐Cal, offering Californians a more equitable, coordinated, and person‐centered approach to maximizing their health and life trajectory.1 DHCS Goals For CalAIM 2 Identify and manage comprehensive needs through whole person care approaches and social drivers of health. Improve quality outcomes, reduce health disparities, and transform the delivery system through value-based initiatives, modernization, and payment reform. Make Medi‐Cal a more consistent and seamless system for enrollees to navigate by reducing complexity and increasing flexibility. Resource Links DHCS CalAIM page DHCS CalAIM Transformation Infographic (PDF) DHCS Medi-Cal Alignment Primer (PDF) IEHP Enhanced Care Management IEHP Enhanced Care Management (Member Page) IEHP Community Support Services IEHP Community Support Services (Member Page) 1,2https://dhcs.ca.gov/calaim You will need Adobe Acrobat Reader 6.0 or later to view the PDF files. You can download a free copy by clicking here.
Plan Updates - Public Health Advisory
- Mosquito Borne Disease Update (PDF) March 17, 2023 - Riverside University Health Systems - Increased Enteric Disease Activity - Shigella (PDF) November 11, 2022 - Riverside University Health Systems - Early Respiratory Syncytial Virus (RSV) and Seasonal Influenza Activity (PDF) October 25, 2022 - Riverside University Health Systems - Outbreak of Ebola Virus Disease Due to Sudan Virus in Central Uganda (PDF) October 21, 2022 - Riverside University Health Systems - Influenza (PDF) August 18, 2022 - Updated Monkeypox Guidance (PDF) August 18, 2022 - Riverside University Health System - Monkeypox Home Isolation Instructions (PDF) August 18, 2022 - CDC - Dear Colleague: 2022 Monkeypox Outbreak (PDF) July 19, 2022 - Updated Monkeypox Guidance (PDF) March 14, 2022 - Riverside County Legionnaires' Disease Advisory (PDF) By clicking on the links below, you will be leaving the IEHP website.
最新消息 - IEHP 宣布 Angelica Baltazar 為新基金會主席
lica Baltazar（社會工作碩士）任命為新成立的 IEHP 基金會的主席。 該基金會是 IEHP 的慈善機構，宗旨是增加地區的慈善事業及慷慨程度，協助填補最弱勢群體的不足之處，並於社區中保留資金。 基金會的工作重心為實現 IEHP 所稱的 Inland Empire 活力健康。活力健康意指 IEHP 的成員和 Inland Empire 的居民將透過解決疾病根源、健康公平和社區核心需求的計畫以獲得更優質、更令人愉快的生活。 Baltazar 在公共衛生和人類服務領域擁有 20 多年的經驗。在加入 IEHP 之前，她的前兩份工作是在 San Antonio Regional Hospital 擔任健康公平的執行主管和在 Lewis-San Antonio 健康社區研究所擔任執行主任。 Baltazar 擁有 Cal Poly Pomona 的社會工作學士學位，以及 Loma Linda University 的政策規劃和管理碩士學位。她是 Inland SoCal United Way 的社區顧問成員，也是 Partners for Better Health and Promise Scholars 的董事會成員。 「找到合適的領導人選，是 IEHP 基金會發展的關鍵第一步，」IEHP 執行長 Jarrod McNaughton 表示。「Angelica 在該領域的專業知識，將支持我們在未來幾十年內努力改善 IE 居民的健康。」
最新消息 - IEHP 發起運動以提高內陸帝國的疫苗接種率
e Health Plan, IEHP) 組織了一系列衛教活動、社區合作夥伴和利益相關者合作計畫，為未接種疫苗的居民提供接種管道和衛教支持。 根據州資料，黑人和西班牙裔社區以及 Medi-Cal 會員在河濱郡和聖貝納迪諾郡的疫苗接種率最低。此外，該地區的 COVID-19 陽性患者個案比率持續大幅波動，帶來持續的不確定性和風險。 「COVID-19 疫苗是我們對抗這種病毒最具『確定性』的方法，」IEHP 醫療長 Takashi Wada 博士說道。「雖然接種疫苗後仍可能感染病毒，但資料顯示，疫苗在減少病毒影響方面非常有效，從而減少了住院和死亡人數。這就是為什麼接種疫苗如此重要。」 自疫苗推出以來，IEHP 已參加了幾次臨時疫苗接種活動，包括與樓瑪琳達大學健康 (Loma Linda University Health, LLUH) 和 SAC 健康系統 (SAC Health System, SACHS) 合作，於聖貝納迪諾郡黑人社區的重要禮拜場所，聖保羅非洲衛理公會主教教堂 (St. Paul African Methodist Episcopal Church, St. Paul AME) 成立 COVID-19 疫苗診所。 透過州 Medi-Cal COVID-19 疫苗接種獎勵計畫 (COVID-19 Vaccination Incentive Program) 的額外資金， IEHP 將繼續與各郡、社區組織、學校和教會發展合作夥伴關係，以建立創新計畫並採取額外措施以提高疫苗接種率。 IEHP 也將制定激勵計畫，以鼓勵 IEHP 網路提供者提高 COVID 疫苗接種率。 「我們了解選擇不接種疫苗人士的恐懼，我們希望在他們熟悉的環境中與其見面，為他們提供接種疫苗的事實、資訊和機會以增強這些人的信心，」Wada 補充道。「熟悉和信任是促成此決策的重要因素，我們很高興能與社區領袖和組織合作，繼續建立這種信任。」 上個月，IEHP 也與姐妹計畫，洛杉磯照護計畫 (L.A.Care) 合作，在屢獲殊榮的演員 Jaime Camil 的幫助下發起一項衛教活動。Jaime Camil 以其在 CW 頻道的《處女情緣》(Jane the Virgin) 和迪士尼頻道的《可可夜總會》(CoCo) 中的角色聞名。這些工作包括在未來幾週內進行 Instagram 直播活動、公益廣告和看板宣傳。 「除了對抗疫情外，我們也在消除一些假消息，」IEHP 執行長 Jarrod McNaughton 表示。「以與民眾相關的方式向社區提供有關疫苗的事實、真實的資訊，可以產生極大的影響。醫療保健是非常個人的決定，我們很高興與這樣一群受人尊敬的夥伴合作，以確保最弱勢的居民能獲得所需的一切，享受最佳照護和健康活力。」 此健康計畫將作為超級疫苗接種站點繼續為聖貝納迪諾郡提供服務，在其庫卡蒙格牧場總部開設診所，並計劃在不久的將來擴大與其他社區健康合作夥伴的業務。如欲深入瞭解，請造訪 sbcovid19.com/vaccine。
最新消息 - IEHP歡迎新任資訊長
以及IEHP的系統設計、開發、實施和支援。 Vinil最近從Health New England加入IEHP，在Health New England他擔任的是資訊及科技長，負責管理獨特的產品組合，將科技的角色從支援性的功能，提升為對組織成長佔有舉足輕重地位的策略合作夥伴。Vinil還為銷售、承銷和會計開發並執行了端對端營運路線圖。此外，他還重新架構並精簡化了生產支援及應用程式開發作業，為機構實現穩定性、可預測性和最佳化。 在任職於Health New England之前，Vinil在紐約擔任American International Group (AIG) 的副總裁暨數位轉型主管。他在擔任這個職位期間，主持了5000萬美元規模的全球數位轉型計畫，其中包含從全世界140個國家遷移和整併數位財產。 Vinil擁有麻薩諸塞州隆美多市 (Longmeadow) 的貝斯佩大學 (Bay Path University) 的企業管理碩士學位，他迫不及待地想要加入IEHP：「我很期待能夠加入團隊，透過合作、創新和策略支援，協助履行IEHP的使命。只要能夠通力合作，我們能夠為會員、服務提供者、員工和社區實現的成果將會無可限量。」 IEHP執行長Jarrod McNaughton表示：「Vinil會讓團隊如虎添翼，我們都很興奮能夠延攬他加入。Vinil在這個領域的經驗和專業知識，能夠為IEHP致力於治愈心靈、鼓舞人心，日復一日努力提升工作效益的努力提供支援。」
最新消息 - IEHP 展開幼兒健康計畫
lp Me Grow Inland Empire (HMGIE) 聯手打造 IEHP 幼兒健康計畫。該計畫透過預防性篩檢、互動課程、有用的資源等，鼓勵父母瞭解兒童（0-5 歲）的發展里程碑。 發展里程碑有助於評估兒童的成長，並且可以為發展遲緩提供早期警示訊號。IEHP 健康教育主任 Jane Wang 表示：｢孩子的成長不僅是身體層面，也可以從孩子的遊戲、學習、說話和行為加以觀察 。」 「最瞭解自己孩子的父母和看護者可能最先發現任何被忽視的里程碑，而這些是構成解決方案的重要部分，」Wang 補充說明。「透過活動和資源提升對於發展里程碑的認識，讓父母有機會更加瞭解他們的孩子，以及他們個人如何影響孩子的成長。」 Jayla（8 個月）的家長 Jessica Cortez 回顧她參與該計畫的時光，她表示：「透過參與該計畫的活動，我學到了不同的方式，得以協助我教育和改善她的學習。如果沒有參加這些課程，我無法規劃出我們現在所做的這些活動。問卷讓我明白應該尋求些什麼，以及我們需要改進哪些方面。」 該計畫與 HMGIE 合作，運用年齡與發育進程問卷 (Ages and Stages Questionnaires, ASQ-3)。問卷的結果為父母提供關於他們的孩子在五個關鍵領域發展狀況的資訊，可以與孩子的兒科醫師討論。五個關鍵領域包括：溝通、粗大動作、精細動作、問題解決和個人-社會。 此外，家長還可以獲得發展篩檢、學前教育和學習材料，在家中促進健康成長和發展。該計畫還包括為父母及其子女開設的虛擬互動 Circle Time 課程，當察覺任何發展問題時，為父母提供支持性資源。 「Help Me Grow Inland Empire 很榮幸能成為 IEHP 健康教育工作者的發展篩檢合作夥伴，」兒科醫師和 HMGIE 醫師倡導者 Marti Baum 醫師表示。「HMGIE 協助 IEHP 轉介的父母和看護者依既定的里程碑評估孩子的發展。當發現問題時，IEHP 的健康教育者會立即開始與家人合作，為孩子提供必要的醫療護理和社會服務。IEHP 和 HMGIE 共同改變幼兒的生活—這樣成功的合作夥伴關係，可以協助我們的年輕孩子在開始就學時做好學習的準備。」 該計畫每週於線上提供，本月將於 IEHP 的 Victorville 社區資源中心恢復面對面互動課程。 「預防性照護和促進健康是我們 IEHP 健康教育的任務核心，」 Wang 表示。「然而，為了真正提供全方面的護理，我們認為也必須持續加強與 IEHP 服務提供者的合作關係–例如利用技術解決方案以便於取得篩檢工具和結果。在未來幾年內，我們希望協助彌合這些努力，讓我們 0-5 歲的年輕孩子能夠在正確的時間獲得正確的照顧，並得以充分發揮他們的潛力。」 IEHP 家長可以寄送電子郵件至 email@example.com 提交篩檢請求，或與孩子一同參加 Circle Time 課程以參與該計畫。如需更多資訊，請造訪 iehp.org，或致電 IEHP 會員服務中心 (Member Service)，電話 (800) 440-4347，TTY 使用者請撥打 (800) 718-4347。